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21 May, 2018 00:00 00 AM / LAST MODIFIED: 21 May, 2018 12:12:11 AM

Inflammatory bowel disease

Dr Wrishi Raphael
Inflammatory bowel disease

Inflammatory bowel disease (IBD) involves chronic inflammation of all or part of your digestive tract. IBD primarily includes ulcerative colitis and Crohn's disease.

Both usually involve severe diarrhea, pain, fatigue and weight loss. IBD can be debilitating and sometimes leads to life-threatening complications. Why it happens is still poorly understood, however several authorities agree that there is a sustained response of the immune system, perhaps to enteric flora in a genetically predisposed

individual. The current hypothesis is that there is a lack of appropriate down-regulation of immune responsiveness.

Genetics:

There is increased risk of both ulcerative colitis and Crohn's disease in relatives of patients with either

disease, especially siblings, especially early onset disease.

The familial risk is greater if proband (a person serving as the starting point for the genetic study of a family) has Crohn's rather than ulcerative colitis.

Certain genetic mutations like CARD15/NOD2 are associated with Crohn’s disease

Chron’s disease is a chronic inflammatory disease of the intestines, especially the colon and ileum, associated with ulcers and fistulae.

Clinical features

The natural history of the disease is unpredictable and it most often presents as recurrent episodes of abdominal cramps, diarrhoea and weight loss. The most common location is ileum and ascending colon.

 Ileitis may present with post-prandial pain, vomiting, mass in right lower abdomen and mimics acute appendicitis. Fistulae, fissures, abscesses are common and extra-intestinal manifestations are more common with colonic involvement. Linear ulcers lead to mucosal islands and "cobblestone" appearance

 With an increased risk of perforation into contiguous viscera (leads to fistulae and abscesses).

Investigations

Colonoscopy with biopsy is the first choice of investigation (less often gastroscopy).CT enterography to visualize small bowel. CRP is elevated in most new cases and is useful to monitor treatment response

bacterial cultures.

Management

Smoking cessation

diet

Fluids only during acute exacerbation

Those with extensive small bowel involvement or extensive resection require electrolyte,

mineral and vitamin supplements

The following drugs are effective in symptom management; loperamide, diphenoxylate, codeine

as they all work by decreasing small bowel motility.

Caution if colitis is severe (risk of precipitating toxic megacolon).

Ulcerative colitis is an inflammatory bowel disease (IBD) that causes long-lasting inflammation and ulcers (sores) in your digestive tract. Ulcerative colitis affects the innermost lining of your large intestine (colon) and rectum.

Clinical features

Chronic disease is most frequently characterized by diarrhea and rectal bleeding but can also have a

bdominal cramps/pain, especially with defecation.

Severity of colonic inflammation correlates with symptoms (stool

volume, amount of blood in stool). Tenesmus, urgency, incontinence may also be present.

Systemic symptoms like fever, anorexia, weight loss, fatigue in severe cases with extra-intestinal manifestations are present with characteristic exacerbations and remissions; 5% of cases are fulminant.

Investigations

Sigmoidoscopy with mucosal biopsy (to exclude self-limited colitis) without bowel prep is often sufficient for diagnosis

Colonoscopy is helpful to determine extent of disease; contraindicated in severe exacerbation

CT colonography (formerly barium enema) if colonoscopy cannot be done; contraindicated in severe disease

Stool culture, microscopy, C. difficile toxin assay is necessary to exclude infection however there is no single confirmatory test.

Management

Mainstays of treatment is corticosteroids, with azathioprine used in steroid-dependent or resistant cases. Changes in diet are of little value in decreasing inflammation but may not alleviate symptoms.n (Reprint)

 

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Editor : M. Shamsur Rahman

Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

Editor : M. Shamsur Rahman
Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

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